Apparent Life-Threatening Events in Neonatal Period: Clinical Manifestations and Diagnostic Challenges in a Pediatric Referral Center|
Kadivar, Maliheh; Yaghmaie, Bahareh; Allahverdi, Bahar; Shahbaznejad, Leila; Razi, Nosrat & Mosayebi, Ziba
Objective: Apparent Life-Threatening Events (ALTEs) is an episode that is frightening to the observer and is
characterized by some combination of apnea, color change, altered muscle tone, choking, and gagging. This
study was designed to evaluate and follow up neonates who presented with clinical manifestation of an ALTE
in a year.
Methods: In this prospective observational study, all of the neonates with episode of ALTE who were
admitted to the Children's Medical Center (CMC) in Tehran, from June 15th 2010 to May 14th 2011 were
enrolled in the study. Data from patients consisting of history, physical examinations, and paraclinical findings
were recorded in a checklist and all followed up 3 to 6 months after discharge.
Findings: During the study period 18 neonates were admitted due to ALTE episode(s) with mean age of
15±13 days. Nine (50%) neonates had previous attacks of ALTE. The most frequent complaint was cyanosis in
12 (67%) and apnea in 8 (44%) patients. In 10 (56%) the event lasted less than one minute, 13 (72%) were
awake, 17 (95%) in supine position and 13 (72%) on their parent's lap. Primary antagonistic impression on
admission was sepsis in 11 (61%) and concomitant seizure in 5 (28%). The most common final diagnosis
according to repeated physical examinations, result of paraclinical investigations and follow up was sepsis 4
(22%) and aspiration 9 (50%). ALTE recurred in none of the neonates during follow up.
Conclusion The rate of ALTE seems to be higher than in this study owing to high incidence of recurrent ALTE.
Although most of these attacks regress spontaneously, more attention should be paid for the underlying
Apparent Life Threatening Events; Infant; Neonate; Sepsis; Seizure